For more and more low-risk pregnant women, the doctor is the last person they call when labor pains strike. Call it managed care backlash to drive-through deliveries. Call it 1920s nostalgia for the ultimate in woman-to-woman care. Or, call it comparable if not better care for the same (if not cheaper) healthcare costs.
However the resurgence is acknowledged, insurance companies and hospitals are witnessing a growing trend of women opting for the enhanced care and attention of nurse-midwife deliveries in lieu of obstetrician/gynecologists deliveries.
The findings of a recent study published in the American Journal of Public Health, confirm what many in the industry have known for years: births attended by certified nurse-midwives (CNMs) are likely to endure less obstetrical interventions than those attended by OB/GYNs.
When the University of Washington assessed the care of 1,300 low-risk women who received care from CNMs, OB/GYNs and family physicians they found that CNMs were less likely to use continuous fetal monitoring, induce or augment labor, utilize epidurals and perform episiotomies. In addition, cesarean section rates were also significantly more conservative, with CNMs performing 8.8 percent compared to 13.6 percent for obstetricians and 15.1 percent for family physicians.
"We have always known that women want nurse-midwives because we provide safe care in a caring environment. Now, the health insurance industry knows that nurse-midwifery care has added value," said Joyce Roberts, president of the American College of Nurse-Midwives (ACNM).
This is not the best news for some OB/GYNs who have issues with how their patient-base and billing could be impacted. "The unenlightened physicians are threatened by midwives because they don't readily understand how midwives can help them. But the enlightened OB/GYNs realize that they can have the ability to treat and serve more patients," said James Unland, president of Chicago-based Health Capital Group. Unland, who negotiates large managed-care contracts, says that there are two compelling factors that support the rising midwifery trend from a provider perspective. "(Health Capital Group. 312/939-6906; ACNM, 202/728-9876)